Monday, August 31, 2009

An article in this week's issue of JAMA - the Journal of the American Medical Association - reports that the FDA has now acknowledged receiving 98 reports of suicides and 188 reports of suicide attempts that appear to be linked to Chantix use. In addition, the Agency has received reports of patients taking the drug being involved in motor vehicle crashes.

According to the article: "Although varenicline’s label had already indicated potential psychiatric risks, the agency has continued to receive reports of attempted and completed suicide in varenicline-treated patients, including some who had no history of psychiatric problems. An FDA analysis, released earlier this year, of varenicline adverse event reports submitted to the agency between May 2006 and November 2007 documented 19 suicides and 18 reports of suicidal behaviors, including 15 suicide attempts... But at a press briefing in July, Rosebraugh said that based on crude counts the agency now has reports of 98 suicides and 188 suicide attempts."

The article also notes that the FDA is requiring the makers of Chantix to conduct clinical studies to determine the incidence and severity of the adverse effects of Chantix: "To better understand the incidence of these adverse events and which patients may be at greatest risk, the FDA is requiring the manufacturers of both drugs to conduct additional randomized controlled trials. Unlike previous studies, these trials will include individuals with preexisting mental health conditions, who make up a disproportionate number of smokers."

The Rest of the Story

One almost wonders what the point of the FDA threatening to take electronic cigarettes off the market is. If Chantix has been studied and has been found to have likely caused 98 deaths and an additional 188 attempted suicides and it is allowed to remain on the market because smoking cessation is such an important goal, then what is the point of removing e-cigarettes from the market while studying its potential adverse effects? Suppose e-cigarettes were to be found to have caused 100 deaths. Would that warrant taking it off the market, since it - like Chantix - is helping people to quit smoking?

However, unlike Chantix - for which there were many immediate post-marketing reports of potential adverse effects, e-cigarettes have been on the market for more than 3 years and there have yet to be any severe adverse effects reported.

In other words, we know that people are dying from taking Chantix but we're going to allow it to remain on the market because it's helping people to quit smoking. We know that there is no evidence that anyone is dying from using electronic cigarettes, but we're going to take them off the market, even though they are helping people to quit smoking.

Sorry, but that just doesn't make any sense.

In the same way, it makes no sense for the FDA to allow Chantix to remain on the market while we conduct studies to determine the incidence and severity of its known deadly side effects, but to take e-cigarettes off the market while we conduct studies to determine whether it even has any adverse side effects.

More importantly perhaps, why are anti-smoking groups calling for the removal of e-cigarettes from the market when we are not aware of any documented severe adverse effects, yet they are not calling for the removal of Chantix from the market even though we know this drug is probably killing people?

One answer, I believe, is the heavy financial influence of the pharmaceutical industry. So far, every anti-smoking group which has called for the removal of e-cigarettes from the market has been found to be financially tied to Big Pharma. The Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, American Lung Association, and Action on Smoking and Health have all received funding of some sort from the pharmaceutical industry. None of these groups, however, disclosed their financial conflicts of interest when they called for a ban on electronic cigarettes.

Thus, I believe that not only are the actions of these groups inappropriate, unsupported by science, harmful to the public's health, and heavily biased due to financial relationships, but these actions are also unethical because it is unscrupulous to advocate for a public policy like this without revealing such an important and relevant financial conflict of interest.

The Milwaukee Journal-Sentinelcolumn by Patrick McIlheran published on May 9th quotes SmokeFree Wisconsin's executive director as stating: "Here's the problem. The tobacco industry puts out these products and no one knows what they are."

A SmokeFree Wisconsin blog post on April 25th made the false claim that electronic cigarettes are produced by Big Tobacco as a marketing ploy to hook kids, but numerous comments on the blog that same day pointed out to SmokeFree Wisconsin that e-cigarettes are not produced by the tobacco companies.

SmokeFree Wisconsin was informed two more times that its claim was false, but as of this morning, it still maintains that e-cigarettes are made by Big Tobacco, having failed to correct, modify, clarify, retract, alter, amend, revise, delete, erase, remove, vary, transform, replace, or in any way adjust its false claim.

The Rest of the Story

This story is very important, because the difference between the initial false assertion and the continued and uncorrected deception is the difference, in my opinion, between a simple mistake and an intentional lie.

When I first heard about electronic cigarettes, I too assumed that they were some sort of ploy by Big Tobacco. However, it took only a few minutes of internet searching to discover that this assumption was false and that in fact, they are not tobacco products at all.

The only excuse for SmokeFree Wisconsin at this point would be if they are not aware that e-cigarettes are not manufactured by the tobacco companies. For many reasons, it is difficult to imagine that they could be unaware of this. First, the commenters on the April 25 blog pointed out that e-cigarettes are not made by Big Tobacco. Second, the newspaper column in which SmokeFree Wisconsin was quoted made it clear that e-cigarettes are not made by Big Tobacco. Third, I sent SmokeFree Wisconsin two emails - with my blog posts - emphasizing that e-cigarettes are not made by Big Tobacco. Fourth, numerous newspaper articles, television stories, and radio segments have come out in the past few months revealing that these devices are not a product of the tobacco companies.

Unless SmokeFree Wisconsin has been vacationing all spring and summer with the web master of the SceneSmoking.org site (which, by the way, still claims that 340 young people die each day from smoking), then there is no way that it would not have found out that e-cigarettes are not a Big Tobacco product.

This would make the continued assertion on its web site an intentional lie, rather than a mistake.

This is a critical difference, because it is the difference between sloppy reporting and unethical behavior that violates the public health code of ethics.

Lying about electronic cigarettes is also of great consequence because it could literally affect the health and lives of hundreds of thousands of Americans. Since hundreds of thousands of Americans are using e-cigarettes and the messages sent out by groups such as SmokeFree Wisconsin affect their decisions about whether to stick with these devices or switch back to real cigarettes, this apparent lie by SmokeFree Wisconsin could result in many vapers deciding to go back to cigarette smoking. This would undeniably result in a greatly increased risk of disease and death for these individuals - not a small price to pay for deception and dishonesty by a public health group.

SmokeFree Wisconsin has every right to its own opinion about what national policy should be regarding electronic cigarettes. But it has no right to deceive, mislead, or lie to the American public in order to support its position. Its continuing to do so harms not only its own integrity and credibility, but that of the entire tobacco control movement as well.

Thursday, August 27, 2009

The "Become an Ex" web site features a document which lists questions that smokers who want to quit smoking should ask their doctor.

"Becoming an Ex" is a quit smoking web site sponsored by a large number of health and anti-smoking groups, headed by the American Legacy Foundation and including several state health departments, the American Heart Association, American Cancer Society, and the Mayo Clinic. The complete list of groups can be found here.

The document instructs smokers who feel like they should quit on their own (cold turkey) not to do so, but instead to ask their physician for smoking cessation drugs.

Question 4 (which they are instructed to write down on a paper and bring to their doctor) is:

"I feel like I should quit on my own, but I am wondering about medicines. How could a medicine, over-the-counter or prescription, help me stop smoking?"

Question 5 is:

"Which medication do you recommend for me, and how do I use it?"

Notice that the question is not: "Do you recommend a medication for me, or do you recommend that I quit cold turkey?"

This is very curious (and unwarranted) advice, since we know that on a population basis, cold turkey quit attempts are the most successful. Moreover, if the patient has already expressed a desire to quit on his or her own - cold turkey - then putting them on drugs is probably the last thing you want to do as a physician.

Nevertheless, this document tells every smoker to ask their doctor which medication to take, not whether or not to use medication.

The Rest of the Story

At the bottom of the document, in the fine print, is a most interesting disclosure: "The development of this document was supported by a sponsorship from Pfizer Inc."

In other words, the rest of the story is that the advice to seek medication use even if your inclination is to attempt to quit cold turkey is biased advice which has the appearance of resulting from a financial conflict of interest: the fact that Pfizer - a pharmaceutical company which manufactures one of the major smoking cessation medications - is a sponsor of the development of the document.

Interestingly, the publication on the site which discusses medications mentions the benefits of Chantix, but does not mention the black box warning: the serious, life-threatening potential side effects of Chantix.

While it is up to private organizations to decide whether to accept corporate funding for their campaigns, it seems troubling to me that a number of state health departments (taxpayer-funded) would be involved in an effort that apparently takes pharmaceutical money to develop its materials. But for any of these organizations to be disseminating a document that was supported by Pfizer and is clearly not appropriate because of that conflict of interest is severely problematic as well.

This story demonstrates the extent to which the entire anti-smoking movement has sold itself out to Big Pharma, the extent to which the pharmaceutical funding is destroying the objectivity of these groups, and ultimately, the extent to which the protection of the public's health is suffering because of the prostitution of objective science and policy to the desire for funding.

Wednesday, August 26, 2009

Despite having two major factual inaccuracies in their blog posts pointed out to them, SmokeFree Wisconsin has apparently chosen not to correct these untruthful statements on their web site.

SmokeFree Wisconsin wrote, in an April 25 blog post entitled "E-cigarettes: The Latest Ploy By Big Tobacco to Hook Kids": "A recent call to our office prompted us to look further into the emerging issue of 'e-cigarettes.' A group of public health advocates has urged the Food and Drug Administration (FDA) to pull e-cigarettes (or electronic cigarettes) from sale in the United States. ... E-cigarettes are often made to look like conventional tobacco products and are marketed to kids by producing them in fruit flavors. A united group of public health advocates, including the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association and the Campaign for Tobacco-Free Kids, sent out a press release commending Senator Frank Lautenberg of New Jersey for demanding that the FDA remove e-cigarettes from the marketplace. FDA officials have been quoted in the past few weeks saying e-cigarettes are a 'new drug' that needs to be approved by the government before it can be sold."

Despite my having pointed out the extreme error in this communication (electronic cigarettes are not produced or marketed by Big Tobacco and are not a tobacco company ploy to hook kids), which completely invalidates the post, and despite numerous commenters on the blog pointing out the same error, SmokeFree Wisconsin did not correct the error, resulting in a subsequent post in which I again notified SmokeFree Wisconsin about the error.

Another more recent communication by Smoke Free Wisconsin also presents misinformation. In a July posting, Smoke Free Wisconsin claims that: "The FDA analysis found carcinogens and an antifreeze component in e-cigarette vapors."

This is untrue. The FDA only tested the cartridges, not the electronic cigarette vapor that is actually inhaled. This is a major distinction, because at the relatively low temperatures (compared to regular cigarettes) at which the nicotine and propylene glycol are vaporized, it is not clear whether or not any substantial amount of these carcinogens or diethylene glycol makes its way into the actual vapor.

Both of these errors remain - without a correction of any kind - despite my having sent SmokeFree Wisconsin my August 12 post which pointed out these mistakes.

The Rest of the Story

For the life of me, I cannot understand why the truth is so threatening to anti-smoking groups, including SmokeFree Wisconsin. Why would the organization not want to correct the factual misrepresentations in its communications, so as not to continue to deceive its constituents and other readers?

All it would take is a single sentence - either in or addended to the blog post - noting that there was a mistake and: (1) in the first case, that e-cigarettes are not manufactured by Big Tobacco; and (2) in the second case, that the carcinogens and diethylene glycol were detected in e-cigarette cartridges, not the vapor. If SmokeFree Wisconsin really wanted to correct the mistake and undo the damage done by their misleading of the public, they could even write a new post which corrects these mistakes and discusses the implications of these new facts for the issue of electronic cigarettes. But even a one sentence correction would be sufficient; yet SmokeFree Wisconsin has failed to provide it.

Instead, SmokeFree Wisconsin continues to mislead the public about two important facts that are central to the debate over electronic cigarettes. The fact that these products are not a ploy by Big Tobacco to hook kids is a critical one that completely changes the debate. It is not like this is a factual mistake that has no bearing on the debate. The fact that SmokeFree Wisconsin is being dishonest about is actually dispositive in the policy debate. If Big Tobacco were producing the product, I myself would not be supporting its continued marketing. That the product is not intended for kids is vital to the proper understanding of the issues.

The initial error could be viewed as a simple mistake, and it is excusable. But the failure to correct the mistake after it has been pointed out is no longer just an innocent mistake. In my view, it is an intentional effort to deceive the public, and it is no longer excusable.

I can only speculate about why the truth is so threatening to SmokeFree Wisconsin and many other anti-smoking groups. It seems that the scientific facts and the truth are of little importance to these groups. What is important is their agenda and if the facts don't support the agenda, then it is not necessary to provide the public with those facts. Better that the public should be misled about the facts but support the intended policy than be armed with the truth and thus be led to oppose that policy.

Tuesday, August 25, 2009

In a press release issued last week, the national anti-smoking group Action on Smoking and Health (ASH) warned the public of the dangers not only of electronic cigarette use but also of "secondhand electronic cigarette smoke."

The press release warns the public of the dangers of exposure to carcinogens it alleges are present in the exhaled vapor of electronic cigarette "smoke."

According to the press release: "The FDA recently reported that it found in samples of e-cigarettes a variety Of "toxic and carcinogenic chemicals" including diethylene glycol, "an ingredient used in antifreeze, which is toxic to humans"; "certain tobacco-specific nitrosamines which are human carcinogens"; and that "tobacco-specific impurities suspected of being harmful to humans - anabasine, myosmine, and nicotyrine - were detected in a majority of the samples tested."

"There is every reason to believe that many of these cancer-causing chemicals are also found in the "vapor" given off by e-cigarettes, says Banzhaf, which nonsmokers in the vicinity are then forced to inhale. These secondhand "smokers" may include infants and toddlers, the elderly, and those with pre-existing medical conditions which may make them especially susceptible to exposure to these chemicals." ...

"People seated on airplanes, or in restaurants and other public places where tobacco smoking has been banned, should not be forced to inhale a potentially dangerous mixture of nicotine, propylene glycol, anabasine, myosmine, nicotyrine, certain tobacco-specific nitrosamines which are human carcinogens, and who knows what else, he says. As the Surgeon General has noted, there is no safe lower level of exposure to any known human carcinogen so, as with asbestos, even fleeting exposures should be guarded against. "

The Rest of the Story

Let's set a few things straight right away.

First of all, if we are going to guard against fleeting exposure to any known human carcinogen, then we would have to immediately ban nicotine replacement products, such as nicotine patches, nicotine gum, and nicotine inhalers, as these products have been shown to contain the same carcinogens as have been detected in electronic cigarettes. However, ASH does not appear to be calling for a ban on NRT products, despite the fact that "as the Surgeon General has noted, there is no safe lower level of exposure to any known human carcinogen so, as with asbestos, even fleeting exposures should be guarded against."

Second of all, ASH seems to be completely oblivious to the notion that the dose of a chemical exposure is an important factor in its toxicity. Peanut butter contains the potent carcinogen - aflatoxin - but I don't hear ASH calling for peanut butter to be pulled from the market to guard against exposures to this carcinogen, to which the Surgeon General has noted there is no safe level of exposure.

In fact, many foods contain trace levels of carcinogens. The FDA has set maximum levels for these carcinogens. For aflatoxin, the FDA requires that there be no more than 20 parts per trillion present in foods (other than milk, for which the maximum allowable level is 0.5 parts per trillion.

What is laughable about ASH's alarmist claim that the carcinogens in electronic cigarette cartridges pose a hazard to bystanders is that the level of carcinogens detected in the cartridges was miniscule. It was comparable to the levels of the same carcinogens present in nicotine replacement products. If ASH is worried about carcinogenic exposure of bystanders who are in the vicinity of electronic cigarette users, it should also be worried about carcinogenic exposure of bystanders in the vicinity of nicotine inhaler users.

But I don't hear ASH warning the public about the potential hazards of nicotine inhaler use to the public. That makes me think that there is something more than objective scientific analysis going on here.

To make ASH's science even more shabby, there is no evidence that the carcinogens in the cartridges make their way into the inhaled vapor. And there is no evidence that they make it into the exhaled vapor of the e-cigarette user. Nor is there evidence that the exhaled vapor of the e-cigarette user causes any significant exposure for bystanders. There is, in fact, very little reason to believe that exhaled electronic cigarette vapor poses any significant threat to nonusers, and there certainly is no significant risk of cancer.

What is so troubling to me about these absurd and unsubstantiated statements by ASH is that they undermine the entire credibility of anti-smoking groups' claims about the hazards of secondhand smoke. If anti-smoking groups are making ridiculous claims about the dangers of "secondhand" exhaled electronic cigarette vapor, what reason is there for the public to believe that they are not also making ridiculous claims about the hazards of secondhand smoke?

ASH is truly undermining the credibility of the entire anti-smoking movement in terms of its claims about the hazards of the real secondhand smoke. The public is going to start to dismiss all of the movement's claims, even those which are scientifically sound.

Perhaps even more concerning to me is why ASH - and other anti-smoking groups - have completely abandoned science to become extremist activist groups that are merely spewing propaganda and hysteria. What exactly is it that is so threatening about e-cigarettes that has led these groups to discard any degree of scientific integrity?

I can only hypothesize here, but my perception is that e-cigarettes are threatening precisely because they are potentially much safer than conventional cigarettes. What this means is that to have any conscience, anti-smoking groups must abandon their abstinence-only philosophy and accept that the best course of action might actually be to encourage smokers to use a product which looks like and acts like a cigarette.

The anti-smoking groups are showing their true colors here. It is apparently not the health effects of cigarettes that are the real problem; it is the cigarette itself. Take away the overwhelming majority of the toxic and carcinogenic chemicals from the cigarette and what do you have? In my view, a much safer alternative to cigarettes. In the anti-smoking groups' view, you still have a cigarette. And that is unacceptable.

Not only does this threaten the abstinence-only philosophy, but it also threatens the status quo: that is, the continued survival and normal business of the anti-smoking groups themselves. Can these groups thrive in an environment in which a cigarette-like product is the life-saving answer to effective smoking cessation for hundreds of thousands or perhaps millions of smokers? Apparently not. They would rather stick with the status quo, where pharmaceutical products are used unsuccessfully by 90% of smokers and continued high rates of smoking justify the expenditure of more money to fund anti-smoking activities and programs.

Remember that ASH is funded heavily by Big Pharma (specifically, by Pfizer - the maker of Chantix). If e-cigarettes really take off, they represent a huge threat to the profits of pharmaceutical companies, and in turn, they represent a threat to future funding of ASH. This conflict of interest is significant, but ASH has failed to disclose it in any of its statements about the dangers of electronic cigarettes. Each of the other anti-smoking groups which have warned the public about the dangers of e-cigarettes is also heavily funded by Big Pharma. Is this merely a coincidence? I think not.

The rest of the story is that ASH has completely lost sight of any semblance of science, and its propaganda has deteriorated to the level of pure hysteria. This undermines the anti-smoking movement's ability to convince people of the very real threats of the real secondhand smoke and it gives the public reason to doubt that anything the movement says about tobacco smoke is accurate. It is not only unethical because it is dishonest, but it is destroying the scientific integrity of the anti-smoking movement.

Monday, August 24, 2009

On Sunday, the Hartford Courant ran an op-ed I contributed which tries to re-focus the debate over electronic cigarettes by honing in on the critical scientific issues, rather than the ideological and political concerns that are driving policy makers, government officials, politicians, and anti-smoking groups who are pushing for the prohibition of these potentially life-saving devices.

While the piece responds most directly to Connecticut Attorney General Richard Blumenthal's threat earlier this week to seek a ban on electronic cigarettes in his state, the points I raise are relevant to the debate over electronic cigarettes in other states and at the federal level.

A critical point that I make in the piece is that the FDA has been very misleading in its presentation of the scientific facts. The FDA has been emphasizing its finding that there carcinogens present in electronic cigarette cartridges and using this finding to try to scare electronic cigarette users into believing that these devices are dangerous. However as I point out: "the FDA failed to mention in its press conference that the levels of tobacco-specific nitrosamines (the carcinogens) detected in electronic cigarettes were extremely low, below the level allowed in nicotine replacement products, such as nicotine patches, inhalers and gum. The agency is not threatening to take nicotine patches or gum off the market, although they too contain detectable levels of carcinogens. The nicotine in electronic cigarettes and FDA-approved nicotine replacement products is derived from tobacco, which makes traces of some tobacco carcinogens essentially inevitable."

Perhaps more importantly, I point out that the trace levels of carcinogens in electronic cigarettes are orders of magnitude lower than in real cigarettes. With the FDA now approving the sale and marketing of conventional cigarettes, it is absurd to think that the Agency would spend so much of its energy on an attempt to remove this much safer alternative from the market, while ignoring the very real threat posed by the cigarettes being smoked by 45 million Americans:

"The level of the same tobacco-specific nitrosamines in conventional cigarettes is at least 300 to 1,400 times higher than what has been detected in electronic cigarette cartridges. In other words, you would have to smoke as many as 1,400 electronic cigarettes to be potentially exposed to the same amount of these carcinogens as smoking one conventional cigarette. In fact, the FDA failed to perform the laboratory test of most importance: a comparison of the presence of, and concentrations of, toxins and carcinogens in electronic cigarettes and conventional ones. Scientific studies have demonstrated that conventional cigarettes contain 57 identified carcinogens, while electronic cigarettes have not been found to contain any carcinogens at higher than trace levels."

"The bottom line is this: Conventional cigarettes have been thoroughly tested. They are known to contain at least 10,000 chemicals, including about 57 carcinogens. Electronic cigarettes deliver nicotine without these 10,000 chemicals and 57 carcinogens. It doesn't take a rocket toxicologist to figure out that electronic cigarettes are a much, much safer alternative to conventional ones. Unfortunately, what the FDA and the anti-smoking groups are essentially telling smokers is that they would rather have them continue to smoke the most toxic cigarettes — the conventional ones — rather than switch to a product that is likely orders of magnitude safer."

I conclude as follows: "The FDA and anti-smoking groups are on the verge of losing sight of the actual objective of public health regulation: to improve the overall population's health. The combination of FDA approval of conventional cigarettes and FDA banning of the much safer electronic ones would be ludicrous, would have detrimental population health effects and would send exactly the wrong message to the public."

"The real threat to our children's health is not electronic cigarettes. It's the real ones."

The Rest of the Story

I think the rest of the story is in the comments of readers of my op-ed, who have shared personal examples of how electronic cigarettes have helped them or their loved ones to improve their health (and possibly save their lives) by getting them successfully off of real cigarettes. When you read these stories, you realize how tragic it would be for the FDA, Attorneys General, and anti-smoking groups to succeed in removing these products from the market, and forcing hundreds of thousands of ex-smokers to return to cigarette smoking.

We have a basic principle in medicine and in public health as well: "First, to do no harm." This principle is derived originally from Hippocrates in his Hippocratic Corpus (Epidemics), and more recently, from the English physician Thomas Sydenham.

If electronic cigarettes had not yet been introduced into the market, one might be able to argue that they should be required to go through the usual pre-approval clinical testing before being introduced. One could argue that prior to knowing how effective such a device might be in helping smokers quit, no harm is done by requiring extensive pre-market testing. However, once the cat is out of the bag and the product has already been on the market for more than 3 years, shown to be effective at least anecdotally through the experiences of thousands of users, and failed to produce any evidence of adverse effects, it would clearly be doing harm to hundreds of thousands of users to take the product off the market.

Everyone can read what I had to say on the issue. But let me close with the words of 3 of the commenters who shared their personal experiences with electronic cigarettes:

"My mother is using the ecig and hasn't has a cigarette since March. My mother, my child's grandmother, was wheezing and had boughts of COPD. Those days are gone, and this 60 year old woman is now walking everyday. The Advair and inhaler haven't been used once. ... for every e-cig user there's family and friends who are ecstatic about the choice the X-SMOKER has made. I then answered some of my kid's questions. Two of them were: "Is the FDA bad? Why does the FDA want grandma to be sick?"

"I smoked for 21 years...after one puff off of my e-cig...I completely quit those nasty normal cigs. The state and feds haven't received any of my sin-tax's since May 8th. Thats about 106 days, a pack a day, $4 of tax per pack....so thats $426 the govnerment doesn't get. The state and feds are afraid that more people will convert to these, and they wont make their blood money. Ban them before they become popular."

"I smoked for more than 10 years and now I've completely stopped smoking normal cigarettes. I can breathe easier and no longer cough. I've tried patches, nicotine gum, you name it! This is the best invention since sliced bread and I'm glad that I purchased a good unit."

Obviously, these comments are only anecdotal evidence for the effectiveness of these products. But there are literally thousands of similar testimonials. And the most remarkable thing is that you are not reading similar testimonials from lots of people who tried electronic cigarettes and found them to be ineffective. You also aren't hearing lots of reports of adverse effects from e-cigarettes (like you are with Chantix, which remains FDA-approved an on the market.

I can only hope that with this op-ed and with continued efforts to educate people about the issue, eventually decisions will be made based on the science and on the basic principle of protecting the public's health, rather than on ideological and political concerns.

Friday, August 21, 2009

An article published last week on the Wall Street Journal's Health Blog quotes Cleveland Clinic CEO Toby Cosgrove as lamenting the fact that he cannot legally refuse to hire morbidly obese individuals and as supporting stigmatization of, and discrimination against, overweight individuals.

As I reported here in July 2007, the Cleveland Clinic has deemed smokers to be unsuitable for employment. New employees are required to undergo a cotinine test and are refused employment if testing indicates that they smoke or use smokeless tobacco.

According to the article: "The Cleveland Clinic doesn’t hire smokers — part of its effort to “walk the talk” about healthy lifestyles, Cleveland Clinic CEO Toby Cosgrove said in a recent chat with the Health Blog. But, according to Cosgrove, it would be illegal to apply a similar standard to people who are obese, because they’re protected by the Americans with Disabilities Act. “I can’t decide that I’m not going to hire somebody because they’re 400 pounds,” he said. “We don’t hire smokers, and that’s perfectly legal.” Cosgrove questioned that rule, suggesting it could hinder efforts to lower the nation’s obesity rate. “We are protecting people who are overweight rather than giving people a social stigma,” he said."

The Rest of the Story

While the Americans with Disabilities Act protects individuals who are morbidly obese, it does not protect those who are merely obese or overweight. Thus, there is nothing to stop the Cleveland Clinic from refusing to hire anyone who is overweight or obese. The Cleveland Clinic is perfectly free to make being thin a requirement for employment. And it's frightening to know that its CEO is even thinking about doing so.

When the Cleveland Clinic first announced that it would discriminate against smokers, I wrote: "Clearly, by its own reasoning, the Cleveland Clinic's policies and procedures do not reflect a commitment to advocating healthy living. While smoking may account for $75 billion in medical costs, obesity accounts for more than $78 billion (even more than smoking). Yet the Cleveland Clinic has not announced a policy to refuse to hire fat people. If the Cleveland Clinic were true to its word about adopting policies and procedures that reflect a consistent commitment to advocate healthy living, then surely they would institute a policy of refusing to hire people who are overweight or obese. As with smoking, such applicants could be referred to a weight loss program and encouraged to reapply after 90 days if they lose sufficient weight.

Similarly, the Cleveland Clinic doesn't appear to care about the alcohol problem that afflicts American society and causes a huge burden of chronic disease. While smokers need not apply, persons who drink too much alcohol are free to seek employment with this health system that considers itself a leader in "preventative" health and wellness. So are those who engage in unsafe sexual activities, eat far too much fat in their diets, consume high amounts of unhealthy trans-fats, or engage in a sedentary lifestyle and get absolutely no physical activity or exercise.

To be clear, what the Cleveland Clinic is doing is discriminating against smokers in employment. They are justifying this selective and targeted employment discrimination on the grounds that it is important to promote a healthy workforce. Yet they show no desire to actually promote a healthy workforce by making sure that prospective employees are actually healthy. They can be as unhealthy as they want to be, as long as they don't smoke."

Now, it appears that smokers may be just the first group that the Cleveland Clinic is trying to purge from its work force. The overweight and obese appear to be next, as soon as Cosgrove gets word that it is only the morbidly obese who are protected by federal law.

Perhaps even more disturbing than the fact that the Cleveland Clinic is discriminating against smokers and supporting the idea of discriminating against obese individuals is the fact that its CEO is arguing for the intentional stigmatization of fat and overweight people as a measure to reduce obesity. Not only is such a measure doomed for failure because stigmatization tends to paralyze people and to create self-fulfilling prophecies as well as remove any self-efficacy or self-esteem that might allow a person to actually do something about their weight, but such a measure is despicable on its face. Moreover, such a measure would almost certainly exacerbate the serious problem of anorexia and eating disorders by further stigmatizing overweight.

Patients of the Cleveland Clinic can no longer be assured that they are being treated by the best medical, nursing, and ancillary services staff. But they can at least rest better at night knowing that the people who treat them do not smoke. Soon, they won't even have to see overweight people in the Clinic's facilities. It will be staff made up completely of thin nonsmokers. Unfortunately, it will also be a staff that is less qualified to provide medical care than the staffs at other health care facilities.

Thursday, August 20, 2009

Connecticut's Attorney General - Richard Blumenthal - issued a warning yesterday against electronic cigarettes, threatening to take them off the market in Connecticut and asserting that they are no safer than regular cigarettes.

According to the Attorney General's press release: "Attorney General Richard Blumenthal today issued a consumer warning urging consumers and retailers to avoid e-cigarettes in the wake of a recent Food and Drug Administration (FDA) analysis finding cancer-causing chemicals and an antifreeze ingredient in some of the devices. ... Blumenthal said e-cigarettes falsely claim to deliver nicotine without the health risks of smoking. He expressed concern they could addict young people to nicotine, leading them to smoke. "Despite their fancy hype and alluring flavors, these products deliver carcinogens in a cartridge," Blumenthal said. "These battery powered devices give consumers no clue that they are inhaling toxic and cancer-causing chemicals, as well as luring children into nicotine addiction. Far from providing a safe alternative to smoking, E-cigarettes pose a serious public health risk. They sell vapor instead of smoke -- with the same health risks and costs. "E-cigarettes are potential nicotine and addiction enablers -- drug pushers, not a smoking cessation aid. Mint and candy flavors cannot mask their menace. Smokers seeking to quit should consult their doctors for safe and effective therapies and products proven to combat nicotine cravings. "Their motto should be: no smoke or mirrors, just plain cancer and addiction."

The Rest of the Story

I challenge Attorney General Blumenthal to provide the scientific data which support his contention that electronic cigarettes are no safer than real ones. I also challenge him to provide the data showing that electronic cigarettes pose any significant cancer risk.

In this press release, Blumenthal goes beyond merely casting doubt on whether electronic cigarettes are safer than conventional cigarettes. He asserts that they are not safer. Not only is there no scientific evidence to support his contention, but even worse, his public statement is extremely damaging. It actually undermines the public's appreciation of the serious hazards of cigarette smoking.

You see, what Blumenthal is saying is that cigarette smoking is no worse for your health than inhaling vapors of relatively pure nicotine, without anything more than trace amounts of the 10,000+ chemicals found in tobacco.

Not only is that assertion unsupported by scientific evidence and not only does it fly in the face of everything we know about toxicology, chemistry, and medicine, but I view that as medical malpractice on a grand scale. Is the Attorney General of Connecticut actually telling vapers that they are better off going back to cigarettes than continuing to use electronic cigarettes? Would he actually advise someone who has successfully quit cigarette smoking through the use of e-cigarettes to start smoking again?

Sadly, and most inappropriately, this is precisely what the Attorney General is saying.

As I have highlighted in many previous posts, the FDA found only trace levels of carcinogens in e-cigarette cartridges and they are comparable to what is found in nicotine replacement products. If Attorney General Blumenthal is so concerned about carcinogens, why is he not warning the public about the carcinogens that we know are present in nicotine gum and the nicotine patch? Why is he not warning the public that studies have shown detectable levels of carcinogens in the saliva of individuals who use nicotine gum?

Moreover, since the levels of carcinogens in e-cigarettes are 1400 times lower than in Marlboros, would Blumenthal not agree that the cancer risk from these products is substantially lower than from smoking?

There is also no evidence that electronic cigarettes are enticing youths to start smoking, much less to pick up an e-cigarette. At a minimum of $60, they are hardly within the range of pocket money of most teenagers. Can Blumenthal give us the name of one teenager in Connecticut who uses the product? If you want to talk about hype, Blumenthal's completely unsubstantiated claims about the addiction of kids by electronic cigarettes fits the bill.

The truth is: there are three types of cigarettes that are addicting kids in the state of Connecticut. They are Marlboros, Camels, and Newports. If the Attorney General really wants to do something to protect kids, his first order of business should be pulling these products off Connecticut shelves, not electronic cigarettes which few, if any, kids in Connecticut are smoking?

Instead, Blumenthal is going to harm the health of thousands of Connecticut residents by forcing them to go back to smoking their Marlboros, Camels, and Newports. Big Tobacco should be thanking the Attorney General for helping to protect their profits by keeping people hooked to their products.

Wednesday, August 19, 2009

According to a communication sent out by the American Lung Association to its constituents yesterday, the FDA tobacco legislation will put an end to kids becoming the next generation of smokers because it bans the sale of candy-flavored cigarettes.

The email states: "We’re winning against the tobacco companies!"

"On June 22, 2009, the American Lung Association won its long-fought battle against Big Tobacco when President Obama signed legislation into law giving the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products. Among other requirements, it restricts deceptive cigarette advertising to kids, and bans the sale of fruit- and candy-flavored cigarettes."

"But we still have so much more to do. The tobacco companies will try to get around the new law by saying certain candy-flavored cigarettes are not covered by these restrictions and can still be sold to children. This is not true!"

"That’s why the American Lung Association will not rest until the FDA fully implements this new law and children are no longer targeted to become the next generation of smokers."

The Rest of the Story

The rest of the story is that the American Lung Association is being dishonest and deceptive in this communication to its constituents. First of all, the FDA tobacco legislation does not ban all candy flavorings in cigarettes. It bans all candy flavorings with the exception of menthol. However, menthol is the only candy flavoring that the tobacco industry is actually using to entice and addict kids. When was the last time you heard of a cherry cigarette? How about a pineapple cigarette? While the American Lung Association makes it sound like Big Tobacco has been defeated because they can no longer use candy flavorings to entice kids, the truth is that the only candy flavoring that it was using - prior to the legislation - was menthol and one candy flavoring that it can continue to use after the legislation is ... that's right ... menthol.

So the American Lung Association, and this legislation, has actually done nothing to protect kids from becoming the next generation of smokers. If anything, the legislation has permanently institutionalized the tobacco industry's ability to recruit the next generation of smokers by protecting the industry's ability to use nicotine to make cigarettes powerfully addictive.

If the American Lung Association is honest about not resting until children are no longer targeted to become the next generation of smokers, then it is not going to be resting any time soon. And the FDA legislation brings it further away from, not closer to, being able to take that rest.

The email is also dishonest in stating that "the tobacco companies will try to get around the new law by saying certain candy-flavored cigarettes are not covered by these restrictions and can still be sold to children." It is blatantly false that the cigarette companies will argue that certain cigarettes can be sold to children. I am not aware that the tobacco companies have ever argued that it is legal to sell cigarettes to children. While I am harshly critical of cigarette companies, I would never lie about them in order to incriminate them for something they have not done, or would not do.

The American Lung Association's statement is so full of lies and deception that it really disturbs me. Although I am a long-time support of the ALA, I simply cannot tolerate this degree of deception, dishonesty, and disingenuousness.

Perhaps the most keen understanding of the truth about the FDA legislation comes not from the American Lung Association but from a tobacco retailer in Kansas City, who "notes the irony that the federal government hoped its flavored tobacco ban would protect kids, and yet the most popular cigarette flavor in the world -- menthol -- remains on the shelves."

In light of Philip Morris' recent introduction of Marlboro Blend No. 54 (which ironically came out the same day that the FDA legislation was enacted into law) -- a new full-flavored menthol cigarette -- how can the American Lung Association possibly argue that we're winning against the tobacco companies with respect to flavored cigarettes. The truth is - we're losing that battle badly and the cigarette manufacturers are laughing as they carry their winnings all the way to the bank.

Tuesday, August 18, 2009

A laboratory analysis of the chemical composition of the electronic cigarette liquid and vapor produced by one brand of electronic cigarette (Johnson Creek Enterprises) has revealed that the ingredients in this product are: nicotine, propylene glycol, and glycerin.

In contrast to the claims of anti-smoking groups, who are telling the public that "we have no idea what is in this product," laboratory analysis has made it very clear that we do know what is in the product: nicotine, glycerin, and propylene glycol. The results of this testing are in line with those of several other laboratory analyses of other e-cigarette brands, which have also confirmed that these are the main ingredients in the product. In previous studies, only trace levels of tobacco by-products (tobacco-specific nitrosamines) were detected. While the present analysis probably does not rule out the presence of trace levels of carcinogens, it certainly suggests that there is no major contamination of these products with carcinogens, indicating that these products are much safer than conventional cigarettes.

Since glycerin and propylene glycol are generally believed to be safe, the only real remaining issue in terms of the safety of the product ingredients is the diethylene glycol which was detected by the FDA in one brand of electronic cigarette. This is most likely a result of the use of non-pharmaceutical-grade diethylene glycol so it can most likely be easily corrected.

The Rest of the Story

The rest of the story is that there simply is nothing behind the unwarranted claims of anti-smoking groups that "we have no idea what is in this product." In fact, we know a lot more about what is in electronic cigarettes than we do about what is in conventional cigarettes. While we know the main ingredients of electronic cigarettes are nicotine and propylene glycol, and that with the exception of one brand of e-cigarette, there are only trace levels of other chemicals present, we do not know the overwhelming majority of the chemicals present in tobacco smoke.

So the next time an anti-smoking group tells you that we need to ban e-cigarettes because we don't know what is in them, you tell them: "Sorry. Good try, but we do know what is in them, and it's a heck of a lot safer than what's in conventional cigarettes. Plus, if you really want to talk about a product for which we have no idea what the ingredients are, try conventional cigarettes. Which reminds me, why did you just lobby to have the FDA approve these products? And what's the logic behind asking the FDA to approve the conventional cigarettes but ban the non-tobacco ones, which contain, we happen to know, nicotine, glycerin, and propylene glycol?"

While further testing of electronic cigarettes is certainly warranted, and while restrictions on the sales of these products to minors and the types of marketing claims that can be made are reasonable, it would be criminal to take these products off the market. Smokers who have found these products to be a life-saver, allowing them to stay off regular cigarettes, should be permitted to have the choice of continuing to use the product while more definitive studies are conducted.

Anti-smoking groups which want electronic cigarettes yanked off the market are going to have to do a much better job of providing a rationale for why they think these products pose serious harm to users, especially in light of the fact that the users of the product are doing so to stay off of conventional cigarettes. If the major ingredients of the product are nicotine, glycerin, and propylene glycol, then how exactly do anti-smoking groups hypothesize that these products cause serious harm to users, and what exactly is the evidence to support those claims? And most importantly, why is it better for the public's health to have these hundreds of thousands of ex-smokers return to cigarette smoking rather than to remain quit through the use of a product that delivers the nicotine without the 10,000+ other chemicals and which has been shown to have carcinogen levels that are up to 1400 times lower?

WFAE radio in Charlotte ran a great story on electronic cigarettes. Perhaps the most interesting part of the story was the physician who stated that e-cigarettes are the best smoking cessation tool he has seen.

Monday, August 17, 2009

In its continued push for the prohibition of the sale of electronic cigarettes in the United States and abroad, Action on Smoking and Health (ASH) is cautioning the public not to trust the facts or opinions expressed by anyone with connections to the electronic cigarette companies because those groups are biased by virtue of their financial conflict of interest.

In a press release that responds to an E Cigarette Directletter regarding an article published in The Peninsula, which erroneously reported that electronic cigarettes have been found to be more harmful than regular cigarettes, ASH writes:

"In summary, in evaluating e-cigarettes, we respectfully suggest that both your publication and your readers not rely upon the largely unsubstantiated representations of sellers (who have an obvious bias and usually no medical training or credibility), some allegedly supported by studies which have not been published in reputable medical journals and which may have been financed by the industry itself (thereby creating a clear conflict of interest)."

"Instead, we would urge your publication and your readers to rely upon the impartial governmental body charged by U.S. law with evaluating such products [FDA], major U.S. national health organizations which are impartial and have the necessary scientific authority and credibility to address these issues, and decisions by impartial and unbiased entities such as the Attorney General of Oregon, Facebook, etc."

"In this regard you should find the links [URLs] set forth in this communication, as well as the many URLs contained in the linked documents, helpful. We urge you and your readers to consult them for the truth. The simple truth is that no reputable scientific study, much less one published in a major scientific or medical journal, has ever shown that e-cigarettes are any less dangerous than conventional tobacco cigarettes."

The Rest of the Story

The rest of the story is that it was discovered this weekend that ASH has a financial conflict of interest of its own, which it has failed to disclose, which has the appearance of leading to bias and partiality in its presentation of the facts and its opinions on the issue of electronic cigarettes.

It turns out that ASH is a major recipient of money from Big Pharma, which stands to lose huge amounts of profits if smokers start turning to electronic cigarettes rather than to existing pharmaceutical products in their attempts to quit smoking.

Specifically, ASH received $100,000 from Pfizer, according to the company's civic organization funding report for the 2nd quarter of 2009. Interestingly, that same report reveals that other recipients of major funding from Pfizer include three of the other major national anti-smoking organizations that are pushing for the removal of e-cigarettes from the market: the American Cancer Society, American Lung Association, and American Heart Association.

Is it merely a coincidence that each of the five major national organizations (the ACS, ALA, AHA, ASH and Campaign for Tobacco-Free Kids) that are lobbying for the removal of e-cigarettes from the market have been heavily funded by Big Pharma, which stands to lose substantial profits if smokers use e-cigarettes in their quit attempts rather than the traditional pharmaceutical products, such as nicotine replacement therapy and Chantix (which is - coincidentally or not - manufactured by Pfizer)?

It certainly has the appearance that these organizations are being influenced by virtue of their own conflicts of interest. It is nice for ASH to call on the public to be skeptical of information they receive from groups with financial ties to electronic cigarette companies, but ASH should have been forthcoming in disclosing its own financial conflict of interest: financial support from Big Pharma. That is every bit as important a conflict and it has every bit of the same appearance of biasing ASH's presentation of information and its opinion on this issue.

However, I frankly find ASH's failure to disclose its own conflict of interest more unethical and unscrupulous precisely because it has gone to great lengths to try to discredit the statements of others because of their conflicts of interest. To me, that makes it even more inexcusable for ASH to then hide its own conflict of interest, which is every bit as substantial, since the pharmaceutical companies (and Pfizer in particular) stand to lose so much money if electronic cigarettes remain on the market.

By the way, since when does an organization (ASH) which maintains that 30 minutes of secondhand smoke exposure raises a nonsmoker's risk of a fatal heart attack to the same level as an active smoker's have "the necessary scientific authority and credibility to address these issues."

And also, since when did Facebook become an authority on the relative health risks of various type of cigarettes? I trust Facebook for a lot of things, but toxicological risk assessments are not one of them.

Now to some brief comments on the substantive scientific issue to which ASH is responding. The original article in The Peninsula stated that: "the “e-cigarette” harms human health far more than the normal cigarette" and that "it contains 40 times as much nicotine as a regular cigarette."

Neither of these statements is true. There is absolutely no evidence that e-cigarettes are more harmful than regular cigarettes, and there is abundant evidence to support the contention that e-cigarettes are much safer than conventional ones. In fact, it doesn't take a rocket scientist to figure out that a product which delivers propylene glycol and nicotine is going to be safer than one which delivers the nicotine along with 10,000+ chemicals, including 57 carcinogens and numerous toxins.

It is also untrue that e-cigarettes deliver 40 times as much nicotine as regular cigarettes. They actually deliver less nicotine than most conventional cigarettes.

So it seems completely reasonable that E Cigarette Direct wrote to the Peninsula to point out its errors. That letter to the editor was entirely appropriate and accurate in pointing out first that electronic cigarettes are safer than conventional ones because they do not contain tobacco and thus are free of the more than 10,000 chemicals delivered by cigarettes. It also correctly pointed out that the FDA's alarmist claim that e-cigs contain carcinogens was meaningless because they were present only at trace levels comparable to those found in nicotine replacement products. Second, the letter correctly pointed out the evidence that e-cigarettes deliver less nicotine than conventional cigarettes.

Nevertheless, ASH took issue with this response and its press release asks the public to assume that electronic cigarettes are as dangerous as regular cigarettes, but without any scientific evidence. ASH writes that "the simple truth is that no reputable scientific study, much less one published in a major scientific or medical journal, has ever shown that e-cigarettes are any less dangerous than conventional tobacco cigarettes."

Well, the simple truth is also that no reputable scientific study, much less one published in a major scientific or medical journal, has ever shown that e-cigarettes are anywhere near as dangerous as conventional tobacco cigarettes.

E Cigarette Direct has now challenged ASH to actually address the substantive scientific issues at hand: is there evidence that electronic cigarettes deliver more nicotine than conventional cigarettes and is there evidence that these devices are more hazardous than conventional cigarettes? That press release concludes: "In a response to Ash published on the E Cigarette Direct website, the company alleged that ASH had not replied directly to any of the points raised by E Cigarette Direct, stating: "We believe that ASH did not deal with the issues we raised simply because there is no logical response." Managing Director Jean Rasbridge said: "We challenge them to re-read our letter, to read our response to ASH, and to actually address the points raised. We believe a dialogue on whether the electronic cigarette is better or worse than real cigarettes will be of more benefit than side-stepping the real issue - is the electronic cigarette safer than conventional cigarettes?"

Of course, ASH will not respond directly to the scientific substance of the issue, just as ASH never responded to the scientific substance of the issue of whether 30 minutes of secondhand smoke exposure increases the risk of a fatal heart attack among a nonsmoker to the same level as that of an active smoker. ASH is hardly an impartial and unbiased source of medical risk inforamation. In fact, its funding by Big Pharma has the appearance of creating a substantial bias in its presentation of scientific information regarding the relative danger of cigarette vs. e-cigarette smoking.

Unfortunately, while complaining about the conflicts of interest of others, ASH failed to disclose its own conflict of interest. Now, instead of merely acting unscientifically, it is acting unethically as well.

Thursday, August 13, 2009

Campaign for Tobacco-Free Kids Undermines International Tobacco Control and Displays Blinding Hypocrisy

Upon the Campaign for Tobacco-Free Kids' insistence and as a result of its vigorous lobbying, the United States has violated the World Health Organization's Framework Convention on Tobacco Control (FCTC) treaty by granting the tobacco industry permanent membership on the scientific advisory panel that will help the FDA implement its tobacco regulations.

This violation was first reported by Glantz, Barnes, and Eubanks in their blistering critique of the FDA tobacco legislation (see: Glantz SA, Barnes R, Eubanks SY. Compromise or capitulation? US Food and Drug Administration jurisdiction over tobacco products. PLoS Medicine 2009; 6(7):e1000118).

According to the FDA legislation, the Tobacco Products Scientific Advisory Committee shall consist of two members of the tobacco industry, including one representative of the major tobacco companies and one representative of the smaller tobacco companies.

However, Article 5.3 of the FCTC treaty states: "Parties should not allow any person employed by the tobacco industry or any entity working to further its interests to be a member of any government body, committee or advisory group that sets or implements tobacco control or public health policy."

The Rest of the Story

It is shameful that one of the nation's leading tobacco control groups has led the charge to put the U.S. in violation of the FCTC treaty.

The FDA has been accused of becoming increasingly politicized and losing its pure science focus. This action by the Campaign for Tobacco-Free Kids and other anti-smoking groups makes the problem much worse, as it politicizes decisions regarding the most dangerous product that the FDA is being asked to regulate.

President Obama, in his inauguration speech, said that under his administration, we would "return science to its rightful place." Thanks to the anti-smoking groups which promoted this bill, the politicization of the FDA is institutionalized, rather than resolved.

Not only does the Campaign for Tobacco-Free Kids' agreement to the tobacco industry representation on the advisory committee clause undermine the entire integrity of the FDA, but it also severely undermines the entire field of international tobacco control.

As Glantz et al. write: "The multinational tobacco companies will almost certainly use the precedent in the FDA bill to undermine implementation of the FCTC elsewhere, particularly since leading health advocates in the United States have been publicly defending this provision. Even though the US is not yet a party to the FCTC, US advocates must consider the global public health impacts of their actions here."

Nevertheless, as Arlo Guthrie once said, this is not what I've come to talk to you about. What I've come to talk about is hypocrisy.

Regardless of one's position on the FCTC treaty itself, we should all be able to agree that it would be blinding hypocrisy for the Campaign for Tobacco-Free Kids to insist that the U.S. violate the treaty - on the one hand - and for the Campaign to urge countries across the globe to sign, ratify, and implement the provisions of the treaty, on the other hand.

Yet that is precisely what the Campaign is doing.

The Campaign is waging an initiative to urge countries around the world to ratify and implement the treaty. The Campaign even has an implementation guide on its web site, in which it declares that countries must follow Article 5.3, which is intended to "protect public health policies from tobacco industry influence."

Thus, the Campaign for Tobacco-Free Kids is full of hypocrisy. On the one hand they are telling other countries they must adhere to the FCTC treaty. On the other hand, they negotiated and supported legislation that puts the U.S. in violation of the treaty.

Thus, the rest of the story is that the Campaign for Tobacco-Free Kids knowingly lobbied for a policy to put the U.S. in permanent violation of the FCTC treaty while at the same time demanding that other countries adhere to the policy.

Wednesday, August 12, 2009

According to a public communication originally put out by the anti-smoking group Smoke Free Wisconsin this past April, electronic cigarettes are merely a ploy by Big Tobacco to try to hook kids.

SmokeFree Wisconsin wrote, in an April 25 blog post entitled "E-cigarettes: The Latest Ploy By Big Tobacco to Hook Kids": "A recent call to our office prompted us to look further into the emerging issue of 'e-cigarettes.' A group of public health advocates has urged the Food and Drug Administration (FDA) to pull e-cigarettes (or electronic cigarettes) from sale in the United States. ... E-cigarettes are often made to look like conventional tobacco products and are marketed to kids by producing them in fruit flavors. A united group of public health advocates, including the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association and the Campaign for Tobacco-Free Kids, sent out a press release commending Senator Frank Lautenberg of New Jersey for demanding that the FDA remove e-cigarettes from the marketplace. FDA officials have been quoted in the past few weeks saying e-cigarettes are a 'new drug' that needs to be approved by the government before it can be sold."

Despite my having pointed out the extreme error in this communication (electronic cigarettes are not produced or marketed by Big Tobacco and are not a tobacco company ploy to hook kids), which completely invalidates the post, and despite numerous commenters on the blog pointing out the same error, Smoke Free Wisconsin has not - to this day (as of the writing of this blog entry) - corrected or updated its communication.

Another more recent communication by Smoke Free Wisconsin also presents misinformation. In a July posting, Smoke Free Wisconsin claims that: "The FDA analysis found carcinogens and an antifreeze component in e-cigarette vapors."

This is untrue. The FDA only tested the cartridges, not the electronic cigarette vapor that is actually inhaled. This is a major distinction, because at the relatively low temperatures (compared to regular cigarettes) at which the nicotine and propylene glycol are vaporized, it is not clear whether or not any substantial amount of these carcinogens or diethylene glycol makes its way into the actual vapor.

The Rest of the Story

The initial reporting of e-cigarettes as being a ploy by Big Tobacco to hook kids might be written off as a careless error resulting from a failure to actually investigate the issue with any rigor. However, the failure to correct or update the post following the clearly communicated information that e-cigarettes are not manufactured by Big Tobacco is inexcusable and suggests that Smoke Free Wisconsin is not interested in communicating accurate information to the public, but instead, is simply interested in presenting information - whether true or not - that supports its agenda.

While one cannot expect an organization to always get it right, and I myself have from time to time made an error in a blog post, the most important thing is that when you find out you are wrong, you correct the mistake. At very least, you update the post to indicate the error and inform your readers of the truth. Smoke Free Wisconsin has done neither.

This is particularly surprising since in the post itself it states enthusiastically that readers should "check back for updates."

There is clearly a lot of misinformation out there about electronic cigarettes, as evidenced by a prominent Huffington Postcolumn which also claimed that e-cigarettes were a ploy by Big Tobacco. Regretfully, there was no correction to the error in that column either, despite the fact that the author took the time to respond several times in the comments section.

It baffles me as to why anti-smoking groups and advocates seem so incapable of simply admitting a mistake and correcting it. Apparently, the agenda is far more important than communicating the truth. Better to let a false statement stand than to tell the truth but in any way detract from your effort to push the agenda.

As Americans for Nonsmokers' Rights instructed me years ago, we don't want to say anything that could possibly be construed as positive about anyone who disagrees with us, even if it means failing to correct a communication that could be misleading and/or misinterpreted by the public in a way that damages the reputation of those individuals.

In tobacco control, the truth does not need to be told, unless it happens to be favorable to our side. The importance of a communication is ultimately judged not by its accuracy, but by how favorable it is to the agenda.

Tuesday, August 11, 2009

According to a 2006 article in the Times Online, the Dundee (Scotland) City Council threatened to remove children from their foster parents if the parents fail to agree not to smoke in the home.

According to the article: "Smokers who already have foster children under five in their care face having them removed if they smoke at home. The conditions are being introduced ahead of a ban on smoking in public places, which will give Scotland some of the world’s most draconian anti-smoking laws. However, critics have branded the latest regulations as irresponsible and over-the-top, claiming that officials are putting political correctness before the needs of children. Murdo Fraser, deputy leader of the Scottish Conservatives, said: “It would be horrific to see children taken from their homes where they are otherwise happily settled simply because one of their parents is a smoker.” Dr John Simmonds, policy director of the British Association for Adoption and Fostering, said: “The priority has to be stability and permanence.” Pam Hibbert, principal policy officer for Barnardo’s Scotland, said the psychological effects of taking a child from an otherwise stable and happy home could be more damaging than the effects of second-hand cigarette smoke."

Also according to the article: "Existing carers who breach the policy will be offered training and information about the harmful effects of passive smoking. “Those still unwilling to adhere to the policy will be the subject of a fostering review to discuss the implications of this in terms of their continued fostering,” the paper says. Asked if this meant carers could lose custody of children, a council spokesman said: “We are not ruling that out.”"

Referring to the policy of no smoking in the home, the Dundee policy states: "Current carers who smoke will be asked to conform to the new policy. Almost half have stated their intention to do so. It is acknowledged that we cannot achieve an immediate policy implementation in the households where the carers are unwilling to conform but will work toward this. Carers who continue to breach the policy will receive training and information regarding the harmful effects for children. All Dundee carers wishing to stop smoking will be offered advice and assistance with this. In the longer term those still unwilling to adhere to the policy will be the subject of a fostering review to discuss the implications of this in terms of their continued fostering."

The Rest of the Story

While this story is a bit old, I publish it in the wake of yesterday's story about the council in Wales which will no longer allow smokers to foster or adopt children because I want to present a picture of the range of rather draconian policies that are being enacted in the name of protecting children which actually do far more harm than good. In my view, this demonstrates the tremendous narrow-mindedness of many anti-smoking groups, which apparently can't see any factors beyond parental smoking which affect a child's welfare.

This policy goes one step beyond the Wales (Merthyr Tydfil) policy as it affects children who are already in foster care.

The thinking of the Dundee council is apparently that being exposed to secondhand smoke in the home is worse than having no family. And that being removed from your family is better than being with your family but having secondhand smoke exposure.

To which I say: absolutely disgusting.

Seriously, this is disgusting. I can't possibly express the degree of my condemnation of this policy strongly enough.

To think that the Dundee council would even think of permanently separating children from their parents (albeit foster parents, but they are still they parents) simply because of the risk of some ear and upper respiratory infections is disturbing.

Exposure to wood smoke also increases children's risk of respiratory infections. In fact, wood smoke is more hazardous than secondhand smoke exposure in terms of respiratory infections because while secondhand smoke only causes upper respiratory tract infections, wood smoke causes lower respiratory tract infections - like pneumonia - which are far more serious.

Is the Dundee council going to also remove children from parents who use wood stoves for heat? Is it also better for children to be taken from their families than for them to have some exposure to wood smoke particles?

It is a shame that councils in the UK are losing the ability to distinguish between risk and harm. Unfortunately, this failure is bound to result in actual harm to children.

While there have been few more outspoken about the hazards of secondhand smoke exposure than myself, I think one needs to have some perspective on the overall factors that affect the welfare of children. Sure, secondhand smoke exposure is one of them. But so is having parents and a family. And frankly, the fact that many policy makers, anti-smoking groups and advocates fail to have any perspective on the relative importance of the two is unfortunate. How they could believe that removing children from a family to protect them from secondhand smoke exposure is in the best interests of the child is absolutely beyond my comprehension. And so, once again, I condemn it in the strongest possible terms.

Monday, August 10, 2009

The Merthyr Tydfil council in Wales has adopted a policy that prohibits smokers from adopting or fostering children. While several councils in Wales have previously enacted policies that prohibit smokers from adopting children under a certain age (such as 2 or 5), this is reportedly the nation's first policy with a blanket prohibition on smokers adopting children, regardless of age.

The policy will apply to new adoptees or foster parents, not to those who already have adopted children or have children in their care.

According to an article at Wales Online: "A Council has become the first in Wales to impose a blanket ban on smokers adopting or fostering children. Anti-smoking campaigners last night welcomed the move by Merthyr Tydfil council, but critics have pointed out there are already not enough foster parents in Wales. They fear the changes might discourage potential carers from coming forward and could jeopardise the future of children already in the care of smokers." ...

"Roslyn Rees, head of operational children’s services at Merthyr Tydfil council, said: “The health, safety and well-being of children and young people are at the heart of policies and practice related to children." ...

"Anti-smoking campaign group ASH Wales said the move was a step in the right direction. A spokesman said: “Children who are exposed to second-hand smoke are at serious risk of pneumonia, bronchitis, headaches and ear infections. Exposure to second-hand smoke has also been linked to the development and worsening of asthma in children."

The Rest of the Story

To me, the rest of the story is that policy makers and anti-smoking groups have developed such narrow blinders that they are only able to see the issue of smoking. Nothing else matters. The overall welfare of a child is evaluated solely on the narrow concern of whether or not the parent(s) are smokers. Whether a child has a parent in the first place is inconsequential. What matters is that the child doesn't have a smoking parent. Better that the child should remain in care without parents, much less loving parents, than that they should be placed with the most loving parents who will provide for all their needs but who happen to be smokers.

The head of the council stated that the well-being of children is at the heart of the policy. Does she not see that the well-being of a child depends on far more than whether or not the parent is a smoker? Is it not far better for a child to have loving parents - albeit smokers - than that the child remains in care? Is it not better to accept as adoptive and foster parents adults who come forward with a willingness to make the sacrifices necessary to give children a loving home, rather than to tell them we're not interested because you smoke? Is it really in the best interests of children in care to tell them that we have found a wonderful couple who is excited about taking them in, but so sorry, we're not letting you out of this place because we heard that the potential mom smokes on occasion?

The ultimate absurdity of the policy is that if you have a sixteen-year-old who happens to smoke who is in need of care, she will not even be placed with a potential family because the potential foster parent smokes. We wouldn't want that smoking adolescent exposed to secondhand smoke, would we? Far better to keep her in care and deprive her of living as part of a family with loving, nurturing parents.

Another absurd element of the policy is that it doesn't even matter whether the potential adoptive or foster parents agree to only smoke outside the home. Apparently, the fact that they are smokers is the problem, not the potential for exposure to secondhand smoke. If the only concern were secondhand smoke, then the council could simply work with prospective parents to make sure they understand the health risks and that they agree to smoke only outside the home. The majority of smoking parents do that anyway.

It is also absurd that the policy doesn't take into account the frequency of smoking. If someone lights up only once a week, and only when they are in particular social settings outside of the home, why should they be ineligible to adopt or foster a child?

It's scary to think that ASH Wales views this as a step in the right direction? Just a step in the right direction? If this is only a step, then I'd hate to see what's at the top of the staircase.

Perhaps the most telling aspect of the Merthyr Tydfil policy on adoption and fostering is that while being a smoker (of any amount and whether or not you agree to smoke outside) is an absolute reason to ban you from adopting or fostering, having a criminal conviction is not.

According to the Council's policy: "We have to complete a check with the Criminal Records Bureau to know if there have been any convictions noted against you. If we are advised of any convictions, we will discuss the nature of these with you. It does not necessarily mean that a conviction will preclude you from becoming a foster carer."

In other words, if you are a convicted criminal, the Merthyr Tydfil Council still seeks your application as a potential foster or adoptive parent. However, if you are a smoker, the Merthyr Tydfil Council does not seek your application as a potential foster or adoptive parent.

I can just imagine a conversation with a young girl in care: "We're sorry, but the nice young couple which told you they wanted to adopt you has been disqualified....yes, I know they seem perfect for you, but it turns out that the woman is a smoker.....oh, don't worry, dear, we have another potential adoptive parent, he's a convicted criminal.....oh, don't worry, dear, it could be worse, at least he's not a smoker."

Friday, August 07, 2009

While I agree that there is a need for research into the relative safety and effectiveness of electronic cigarettes, there is also a need for anti-smoking groups and the FDA to study the experience of electronic cigarette users with this product. The passionate testimonials of hundreds of electronic cigarette users suggest that these devices are effective in helping smokers to quit and stay off cigarettes.

I challenge the anti-smoking groups and the FDA to read all of these comments and then to reiterate their position that electronic cigarettes must be taken off the market.

These are all the comments from electronic cigarette users in response to Dr. Whelan's Washington Timesop-ed piece. They are taken from the Washington Timessite as well as the Diggsite for this article. I have not omitted any comments from electronic cigarette users, which is remarkable because there is not a single comment from a user who has not found these devices to be effective in smoking cessation.

The Rest of the Story

"I smoked traditional cigarettes for 27 years.... 2+ packs a day. On June 11th, my first e-cigarette starter kit arrived in the mail. I opened it up and started using it. I have not had a traditional cigarette since that day!! Even if there are some risks associated with these products, it can NEVER be as dangerous as traditional cigarettes so WHY would the FDA (or anyone else) want to stop me and other smokers from using them??? THANK YOU Dr. Whelan for putting this in proper perspective!!"

"Do not allow this product to be taken off the market. It saved my life (my smoker's morning cough disappeared in 3 days after switching to an e-cig) and many thousands more. The FDA is being unbelievably hypocritical in this matter and it shows how politics and money, rather then genuine concern for public health, is behind everything they do. And this is coing from a registered Pharmacist."

"E-cigarettes (also known as Personal Vaporizers) got me off smoking after 20 + years. They're a miracle IMO. The deeply flawed FDA study is being used as a propaganda tool to mislead people about these devices. Their implication that e-cigarettes are just as dangerous as traditional smoking is absolutely incorrect. E-cigarettes save lives."

"E-Cigarette got me off 2 pack a day habit."

"I was a 30+ yr. smoker. None of the other stop smoking aids ever helped me. My blood pressure was out of control. After 8 days of use I was able to stop smoking entirely and my blood pressure has come down substantially. I've been smoke free for 3 months now. I think it would be a travesty to take these away from thousands of people and tell them to go back to smoking."

"I still have a pack of Marlboro cigarettes unsmoked since I took a first puff of these 2 weeks ago. To take them off the market would be a horrible idea and drive many smokers back. Of course tobacco companies and governments stand to lose billions in revenues if these catch on... and they will... so expect to see everything thrown at these new e-cigarette startups to stop this trend."

"I have smoked for nearly 20 years and NEVER went a day without smoking at least a full pack of smokes. Ever since I got my E-cig (3 weeks ago), I never had another reg cig since... I feel better, breathe better, sleep better and thats just to name a few. These are choices we made, please don't take these life changing choices from us!"

"I haven't smoked a tobacco cigarette in over 20 days thanks to the e-cigarette. Nothing else worked before. If this device becomes illegal, it will cause me to go back to using tobacco products or get a prescription to aid in my addiction which has more harmful side effects. Spread the word, this device is helping people lead healthier lives."

"Many of us, e_smokers, would have to go back to smoking regular cigarettes and harm not only yourself but non-smokers too with second hand smoke, increase health insurance cost and so on..."

"I use electronic cigarettes and have cut my consumption of tobacco cigs from a pack a day for 40 years to 1-5 cigarettes a day. I actually now prefer electronic cigarettes, and in the process have gone from thousands of chemicals in smoked tobacco to about 4 in e cigs. Do the math."

"I was smoking the traditional cigarettes for 20 years until I heard about the electronic cigarette. I have not touched a traditional CANCER stick in over 4 months, and I have slowly reduced my nicotine down to the lowest strength. I believe the FDA is working hard on this situation, my main question is, who are they working for. It makes no sense to stop an obvious safer alternative, for the ones they are trying to push us back on that kills over 450,000 people a year."

"I too smoked cigs for 25 years. I bought myself a kit, started "vaping" and haven't looked back."

"Almost 45 years a smoker at better than two packs a day. In less than two days I got rid of the wheezing, coughing and my tobacco cigarette intake dropped to less than five a day and falling. Someone in the FDA needs to see that there is a difference between trace elements of a carcinogen found in the e liquid (the vaporized liquid wasn't even tested by them) and the 60 some know heavy dosages of carcinogens found in cigarettes."

"I was a smoker for 10 years, tried to quit dozens of times. This product is the only thing that has made it possible for me to quit. Please don't ban e-cigs."

"I don't use e-cigs as a smoking cessation device. They are not for smoking cessation, although, many have quit smoking because they have this alternative. It is a much safer alternative, than inhaling 4000 chemicals the tobacco companies only recently admitted to. This is an alternative. I quit smoking over 3 months ago, prior to using an e-cig. I found that I missed the ritual, much like I'd miss having a cup of coffee in the morning. If for some reason I couldn't drink coffee anymore, I might have a cup of tea, or perhaps some other warm drink in my cup. Why on Earth couldn't I have an alternative to a deadly cigarette? Now I have come to know, after talking and listening to many people who have been using e-cigs, that they are very concerned over the safety of what is being inhaled, so much so, that they'd rather use this, than buy what they know is infinitely more harmful, tobacco cigarettes. Many are also not "vaping" nicotine at all!

When I smoked about 2 pack of cigarettes a day, I was wheezing, out of breath, and feeling horrible. The one room I smoked in was covered with tar, and smelled terrible. Since using the e-cig, there is no smell, I have no wheezing, I don't feel sick. There is no second hand smoke to keep from my family."

"I smoked for 25 years, and tried to quit (and failed) at least 5 times. My e-cig made it so easy. It took between 1 and 2 weeks, but the desire for a regular cigarette just melted away. You have to actually want to quit--but if you do, these things make it SO EASY!!! I haven't had a real one in 8 months and I don't miss them at all."

"I started smoking at age 19. From there, I smoked for 9 years until I was 28. I considered myself a casual / light smoker. A pack of lights or ultra-lights would last me about a week/week and a half. It was easy to switch over to e-cigs. Haven't touched a cigarette since. I love my e-cig."

"Massive Harm Reduction! 30 years of smoking cigarettes and now an alternative that works."

"I'll throw my 2 cents in to say e-cigs enabled me to quit after many many years of smoking. I thought I'd never be able to quit. These things are fantastic as a cigarette replacement. Still addicted to nicotine but nothing like the addiction I had when the delivery system was a cigarette."

"Great to read something positive about E-Cigarettes. I've been using this product for about 6 months and I have completely quit smoking cigarettes. I didn't even purchase this product for that- I was just curious. I found that the urge to smoke disappeared completely within a week of using this product. It makes me sick to think that the FDA could be so negative about a product that could potentially save millions of Americans from death."

"My wife and (Me 30yr smoker her 6yr smoker) have tried everything patches gums pills cold turkey and nothing has worked until now. We plan to quit within 3 months not long term."

"We are no longer smoking ANY tobacco cigarettes and feel great. We have already dropped from 24mg to 18mg and plan to keep going until finished with nicotine. we then may choose to use 0mg for as long as it takes to loose the psychological addiction. That is the real tough nut. I quit for a year once and went back. If I had the e-cig I would have used them and not gone back to the real cigarettes resulting in an additional 10 years of smoking."

"Thank you Dr Whelan. As corny as it sounds I almost cried when I read this. We as a people have been bombarded with the false claims of the FDA on this device, however, I truly feel it can save my life. I have tried every cessation method out there with no success until the ecig. I am a former two pack a day smoker and have not even looked back."

"I’ve been a life long cigarette smoker (35 years) whom has unsuccessfully attempted to quit many times. After the failure of the patch, nicotine gum, prescription drugs and cold turkey attempts; I have the e-cigarette to thank for my success."

"I have smoked for 20 years and have been 5 months now tobacco free because of e cigarettes. I have not touched a real cigarette since the day I received my electronic cigarette. Before that, NOTHING could get me off the tobacco cigarettes. I am taking in very low doses of nicotine and have reduced my nicotine immensely. The e cigarette has changed my life and I will never go back to smoking again. This is a crime to try and take this away from me. Without a doubt I know that what I am doing is WAY safer than smoking real cigarettes. SHAME on the FDA for what they are trying to do to us while they sit there and allow real tobacco known and proven cancer causing cancer sticks."

"These devices are a miracle. I tried everything to quit. Nothing worked. I quit cigarettes on the first day with ecigs. I am an adult. This is my choice and no one elses. Why would you force someone to go back to cigarettes?"

"After using an e-cigarette for 4months and 5 days, the only side effect I can report is I have been tobacco free all that time. I didn't buy it to quit smoking; I bought it to cut back my usage a little. NEVER would I have expected this to take the place of my tabacco cigarettes! And yes; I've used the patch, gum, drugs, candy sticks - all those APPROVED methods. I've 'suffered' with smoking for over 25 years. Is this the same as smoking? Well, when I asked my Dr, he said "*ell no! Congrats! you are now a NON SMOKER!""

"After 25 yrs of smoking, I have finally found something to get me off of the tobacco, tar, carcinogens and fire."

"I was an analog cigarette addict for 40 years. Forty Years. for Forty years, I was degraded and looked down upon by co-workers, even fired from one job by a boss who swore I 'smelled like cigarettes'. I've been subjected to restriction to designated smoking areas which are unsafe, poorly maintained, inconvenient and invariably exposed to the elements. I've been penalized by health insurance companies with higher premiums, even tho I've never been sick. I've been taxed exorbitantly by a government who capitalizes on my addiction. I've been lied to by Big Tobacco about what's in their product. I've been ripped off by Big Pharm with their snake-oil cessation products with alarming side-effects that invariably do more harm than good. And then I found the e-cigarette. And ended my days of paying up to $3/day/pack in taxes. For Forty Years. Ended my days of being analog cigarette dependent. My self-esteem is back. I haven't picked up a Big Tobacco cigarette in a month. for the first time in Fourty years. I may still die from 40 years of smoking, but at least I won't be surrounded by cigarette butts and ashtrays and I will have finally kicked my addiction. e-cigarettes save lives."

"I smoked for 25 years. Last year April I found out about the e-cigarette, started using them and I had my last real cigarette July 20th. of last year. So thankfully I am a nonsmoker now for over a year. I will never go back to smoking, will stick around for vaping. I feel better, I don't have a smokers cough anymore, I have more energy. Most people who quit smoking will gain weight. I have not even gained one pound. Also I have been saving a lot of money by not having to spend $ 4.00 on a pack of cigarettes. All in all it's a winner."

"I use a device called the electronic cigarette as a part of a personal harm reduction strategy, and it has helped me to break my 30+ year addiction to tobacco cigarettes. This device contains absolutely no tobacco and creates no smoke, yet provides some of the chemical, physical and psychological aspects of smoking without the deadly effects of a tobacco cigarette. I wish I had never made the foolish decision to smoke as a youngster. My wife of twenty years has never seen me without a cigarette in my hand. I can find very few family photographs that do not show me with a cigarette in my hand. I was completely addicted to tobacco. Two days after I chose to begin using an electronic cigarette with a fluid containing propylene glycol, water, flavorings and nicotine (optional component), I stopped smoking tobacco. I breathe easier, my sense of taste and smell has greatly improved and I no longer reek like an ashtray! Am I now addicted to another device, perhaps; but I am damn comfortable with my decision to inhale nicotine (think nicotine inhalers from drug companies) and propylene glycol (think theater fog). I can control my nicotine intake, I have the option to gradually reduce my nicotine intake and will trust my body to tell me if I am doing something wrong or harmful. My other recourse was to continue to burn thousands of chemicals in tobacco while I wheezed and coughed my way to death. I chose to make a change and the electronic cigarette has improved my life."

"I smoked for 45 years, tried to quit several times only to fail again. I discovered ecigs and within 14 days I quit, I have not touched a cigarette now for six months. I have no desire to smoke tobacco, in fact find it utterly repulsive now. This option could improve the lives of a lot of people not to mention health related cost savings."

"I have been perfectly content since stopping all analogs from day one after my e-cig arrived. A little on the jittery side for the first couple months, and after I switched away from PG to VG, I am now really content, no more jitters, if fact, so content that almost 3 weeks ago now I dropped the nicotine density of my juice from 24mg/ml down to 18mg/ml, with no side effects whatsoever! I find that fascinating, how can that happen when it never happened that way with analogs...if I cut down, I was a physical and mental MESS!!! So what is the secret? It's just a bad system? Tell that to the Doc that just published that article in the Wash Times! She seems to think it's a great idea. AND, that is why these tests have been valuable to me. I wanted to know the truth about what I was actually pulling into my body. And oh yes I was pulling nicotine into my body, and true to the testing done by Ruyan group, it is exponentially lower than when compared to a tobacco cigarette! That was the whole idea! And, if it quenches the god-awful withdrawal side effects of conventional and FDA approved NRT's (nicotine replacement therapy) PLUS gives the person using the options each individual needs to be able to stop smoking cigarettes, Lo and Behold, it has proven itself to be the very BEST kind of NRT. We're happy, this bunch, for some it may be just something new to do, but for me it was for quality of Life and removal of toxins and poisons that I knew and have known for a long time would eventually cause my death! That's pretty powerful, to me. I am now feeling more alive than I have at any time during my 44 years of smoking tobacco cigarettes."

"I have been using the e-cigarette for two months now with no side-effects and with almost no nicotine. I was almost a pack a day smoker and have no desire to go back to cancer sticks. Actually I take that back - I have had side effects, like being able to run without getting winded, more energy, and a better sense of taste/smell. I find the FDA's objections to the e-cigarette to be highly questionable."

"I smoked for 45 years one and half packs a day. Tried to quit numerous times and failed. I discovered ecigs and within 14 days I quit completely and have not had a desire to go back. This could improve the lives of many not to mention health related cost savings."

"I was a 1 1/2 to 2 pack a day smoker for over 40 years. When I first tried e-cigs it was to try to slow down on my tobacco cigarette smoking. My smokers cough was out of control. I coughed and hacked all the time, night and day. After about a week on e-cigs the cough was GONE!! I didn't start out to stop smoking, but it happened. I feel so much better! I can breath again. My sense of smell and taste have returned an I don't smell like cigarettes anymore. I don't need a lighter on me all the time and I don't need ashtrays either."

"I have been a smoker for 25 years and with the e-cigs I have been able to quit smoking real cigarettes. I am so grateful for this story I could really tear up."

"In this decade it's been nearly impossible to find honesty coming from a news source. Now that I can finally breath again since switching to e-cigs 5 months ago, I can truly appreciate a breath of fresh air."

"After 25 years of smoking, and at least 5 failed attempts to quit, I finally did it with my electric cigarette. And it was so incredibly easy, I didn't realize I was doing it--the urge to smoke real cigarettes just fell away over the first week or two I had it. Patches, gum, willpower, and Alan Carr all failed me, but this actually worked."

"I, too, smoked those "nasty stinkies" (tobacco cigarettes) for 40 years, tried all of the "smoking cessation" rip-offs, to no avail, until 9 months ago, when I bought my first E-Cig...2 1/2 weeks later, I had smoked my last tobacco cigarette! Now, 9 months later, I never would have imagined I would feel this good & healthy at the age of 60. I thank God for the invention of the electronic cigarette. Please, God, don't let them take THIS away from us. We want to live."

"I have not had a cigarette for 7 months. I detest the smell of them. I can't believe I smoked for so long. I started out with medium strength, then went to low, and I am now at extra low. I have not coughed in months. I no longer hear myself wheezing in bed. If the ecig has done all this for me, how can it be bad?"

"I have used e-cigarettes for over a year and have experienced health benefit from using them personally. I have had major health problems and the NRT's currently available, did not help and caused side effects. I hope more Doctors, join in this fight for harm reduction in using e-cigarettes."

"After 37 yrs of cigarette addiction, and many unsuccessful attempts to quit; it was only e-cigs that actually enabled me to give up smoking. This product has saved my life. It gets even better. Within a few weeks of using this product, I was down to level ZERO with the nicotine. There were no side effects. That suggests to me that my addiction was more in the mechanics of smoking."

"I smoked for 25 years, and tried to quit (and failed) at least 5 times. My e-cig made it so easy. It took between 1 and 2 weeks, but the desire for a regular cigarette just melted away. You have to actually want to quit--but if you do, these things make it SO EASY!!! I haven't had a real one in 8 months and I don't miss them at all."

"I smoked for 32 years and have been using the E-Cig for 2 months. I really needed to quit because I have Diabetes and other health problems. The Doctor said I was "a ticking time bomb" for stroke or heart attack. NOW? My blood pressure is back to where it was 32 YEARS AGO!! And my lungs were described by my Doc as "wonderful" I feel so much better. Thanks to a PV I have not polluted the air around me for almost 3 months. I did not buy this devise with the intention of quitting tobacco cigarettes, I was tired of being forced outdoors in all weather to feed my addiction. Within 2 weeks I was tobacco free by accident."

"I bought my first ecig last Friday. One week without a cigarette! I breathe better, I smell better, and I am excited and hopeful for a better future!"

"I quit smoking real cigarettes from the very first day after being a pack a day smoker. I can breathe again. I can smell again, I'm not as tired either."

About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 25 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.